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Query: UMLS:C0030305 (pancreatitis)
 16,014 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The amylase/creatinine clearance ratio (Cam/Ccr ratio) was determined in 239 subjects. In 87 hospitalised patients without pancreatic disease (controls) the Cam/Ccr ratio was 3.02 +/- 0.69 (mean +/- ISD). The ratio was above the normal range in all patients with acute pancreatitis but was normal in those with chronic pancreatitis and carcinoma of the pancreas. In 18 patients with choledocholithiasis a raised ratio distinguished those with pancreatitis as assessed independently by the surgeon at laparotomy from those with a macroscopically normal pancreas. Raised Cam/Ccr ratios were also found in diabetics with ketoacidosis and in three patients with fulminant alcoholic liver disease. Though a positive correlation was found between the Cam/Ccr ratio and serum creatinine concentration, abnormally high ratios did not occur in 30 patients with chronic renal failure. A significant increase in Cam/Ccr ratios was produced in six healthy volunteers by intravenous injection of glucagon. However, it is unlikely that hyperglucagonaemia alone accounts for the increased Cam/Ccr ratio seen in acute pancreatitis, as no correlation was found between the clearance ratio and the plasma glucagon concentration in a series of patients. In two other patients in whom excess circulating pancreatic polypeptide was detected the Cam/Ccr ratio was normal. It is concluded that, in view of the sensitivity and relative specificity of finding an increased Cam/Ccr ratio in acute pancreatitis, its determination should be valuable clinically, especially in those cases of hyperamylasaemia where the cause is in doubt. The mechanism whereby the ratio is increased is unknown, and it is unlikely that either glucagon or pancreatic polypeptide is a major factor in its production.
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PMID:Mechanism and specificity of increased amylase/creatinine clearance ratio in pancreatitis. 60 90

This review of the English literature on amylase was undertaken because no recent discussion of the subject could be located, no comprehensive list of disorders causing hyperamylasemia or hyperamylasuria is available, and several major advances in the area have been made, notably the amylase isoenzyme determination and Cam/Ccr ratio. Several important concepts have emerged from this review. First, hyperamylasemia and hyperamylasuria are not specific indices of the presence of pancreatic disease or damage. Second, serum and urinary amylase levels can be spuriously normal with hypertriglyceridemia and pancreatitis. Third, the current emphasis on diagnostic methods for measuring serum amylase isoenzymes promises to improve the specificity of this determination. It will also enhance our understanding of the sources, distribution, metabolism, and elmination of amylase. Fourth, the development of the Cam/Ccr ratio may provide a practical diagnostic tool for separating clinically significant hyperamylasemia due to pancreatitis from that caused by other factors. Both the the isoamylase determination and Cam/Ccr ratio clearly require future research to place their clinical application in the proper perspective.
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PMID:Amylase--its clinical significance: a review of the literature. 78 63

Serum amylase activity and the amylase:creatinine clearance ratio (Cam:Ccr%) are two of the most commonly used indicators for the diagnosis of pancreatitis. However, published data on the effect of pregnancy on these indicators are conflicting. Furthermore, there are no published data on the effect of pregnancy on serum lipase activity, which is considered one of the most sensitive and specific indicators of pancreatitis. A study was undertaken to determine the effect of pregnancy and gestational age on serum amylase, serum lipase and Cam:Ccr% levels and to establish a baseline of normal values for use in the diagnosis of pancreatitis in pregnant women. Serum amylase, serum lipase and Cam:Ccr% levels were determined on a sample population consisting of 175 pregnant women with gestational ages ranging from 5 to 40 weeks and on a control group of 44 reproductive-age, nonpregnant women. The study results indicated that there is no significant difference in serum amylase, serum lipase and Cam:Ccr% levels between pregnant and nonpregnant women. Cam:Ccr% showed a small but statistically significant increase in the third trimester of pregnancy.
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PMID:Pancreatic enzyme activity in pregnancy. 171 46

Total serum amylase activity, its isoenzymes and pancreatic to salivary amylase (P/S) ratio were studied in 40 normal subjects and 47 patients with renal failure, 32 with benign and 15 with malignant conditions. Amylase to creatinine clearance (Cam/Ccr) was studied in 17 normals and 14 patients with renal failure, 10 benign and 4 with malignant diseases. Total amylase activity, and pancreatic and salivary fractions were found to be increased by about 3.4 times the normal in both benign and malignant conditions producing renal failure though the P/S ratio was within the normal range. However, the increase in the urea and creatinine levels in patients could not be related to the increase in serum total amylase. Besides the Cam/Ccr ratio was elevated in patients with both benign and malignant conditions producing renal insufficiency whereas the Cam and Ccr were individually found to be decreased. Why patients with chronic renal failure in both conditions without clinical evidence of pancreatitis should have elevated Cam/Ccr ratio is not clear.
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PMID:Hyperamylasaemia & related enzyme factors in renal failure associated with benign & malignant conditions. 172 Apr 21

The Cam/Ccr% has been suggested to be of value in the diagnosis of pancreatitis. The Cam/Ccr% was determined throughout gestation in normal pregnant and nonpregnant patients. The Cam/Ccr% was lower (p less than 0.05) throughout pregnancy and was a function of increased creatinine clearance. The Cam/Ccr% was increased in pregnant patients with pancreatitis. Two of four patients with the clinical diagnosis of hyperemesis gravidarum demonstrated elevations of the Cam/Ccr%. Toxemia with epigastric pain was noted to be associated with an elevated CamCcr% in all patients, whereas toxemia without epigastric pain was not routinely noted to be associated with an elevated ratio. The normal Cam/Ccr% in pregnancy is lower than the nonpregnant value, and this should be taken into consideration when evaluating a patient with suspected pancreatitis who is pregnant. Patients with the clinical diagnosis of hyperemesis gravidarum and toxemia should be screened with serial Cam/Ccr% for possible evolving pancreatitis.
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PMID:The amylase/creatinine clearance ratio in normal pregnancy and pregnancies complicated by pancreatitis, hyperemesis gravidarum, and toxemia. 615 8

In 21 healthy volunteers the ratio of amylase clearance and creatinine clearance (Cam/Ccr) was determined in urine collected at admission, after a 1-hour collection period and after a 2-hour collection period. The normal values were 1.8 +/- 1.6%, 1.9 +/- 2% and 2.0 +/- 1.7% respectively. They were comparable with those published by others. The reproducibility of the method was acceptable (r = 0.62). When compared with serum amylase determinations, Cam/Ccr showed neither better sensitivity in 19 patients suffering an acute episode of proven pancreatitis, nor better specificity in 19 patients with acute abdomen but no evidence of pancreatitis.
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PMID:[Ratio of amylase clearance and creatinine clearance in the diagnosis of acute pancreatitis]. 616 43

As there are controversies about the specificity and the sensitivity of the amylase clearance/inulin clearance ratio (Cam/Cin) in the diagnosis of pancreatitis, this ratio has been calculated: (a) in rats with induced pancreatitis with histologically proven lesions; (b) in toxic induced tubulopathy rats with lesions demonstrated histologically and biologically (enzymuria). Hyperamylasaemia was found in 86% of the pancreatitis rats at 24 h, 50% at 48 h and 25% at 60 h. The ratio Cam/Cin was elevated above 2 SD of the control values among 14% of the rats at 24 h, 50% at 48 h and 25% at 60 h. There were no changes in enzyme elimination rates in the urine as compared to control values. Renal histology remained normal. Histological scores expressing a severe haemorrhagic pancreatitis were identical at 24, 48 ad 60 h. In toxic induced tubulopathy rats, amylasaemia remained normal. but the Cam/Cin ratio only increased when the glomerular filtration rate was diminished by 90%. The diagnosis could only be made by hyperamylasaemia in 50% of the histologically proven pancreatitis in the rat. The use of the ratio Cam/Cin does not increase the frequency of a correct diagnosis. Finally, amylase must be only filtered by the kidney as no tubular enzymes appeared in the urine of pancreatitis rats. Furthermore, this ratio is not specific for pancreatitis as it could be elevated in other pathologic states such as severe renal failure.
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PMID:Lack of sensitivity and specificity of the renal clearance of amylase/clearance of inulin ratio in experimental acute rat pancreatitis with a study on the renal handling of amylase. 617 May 16